Billing Direct Rates for EFT & Credit Card Processing:
Canada
EFT
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CREDIT CARD
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I have read and understood the above rates
x
NOTES/EXCEPTIONS: This section is reserved for Sales Representative use only.
Please read this entire document. Complete every section that applies to you based on the instructions provided. This
application must be signed and dated.
Merchant Documentation Required
Signed and completed merchant application form
Void cheque showing legal name and company address/letter from financial institution confirming bank details, or deposit slip and
starter cheque
Completed SAQ A form
PLEASE NOTE:
•
Each item listed above is required before your application can be accepted.
•
Once the application has been completed and signed and the required documentation gathered, please email or fax the complete
package to:
•
v.013014
2 of 5
Initial Here _____________
NBX M
ERCHANT
S
ERVICES
I
NC
.
Merchant Application
888 Dunsmuir St. Suite 1400 Vancouver, BC V6C 3K4 3500 Blvd. de Maisonneuve W., Suite 700 Montreal, QC H3Z 3C1 Tel (866) 826-8003 sales@optimalpayments.comP
R O C E S S I N G
A
G R E E M E N T
I
N F O R M A T I O N
S
U M M A R Y
Date of Merchant Application
and Agreement
Effective Date of Application/Agreement ___________________________________
Sales
Representative
___________________________________
Payment Service Provider
NBX Merchant Services Inc. (Optimal Payments)
3500 Blvd. de Maisonneuve W., Suite 700
Montreal, QC H3Z 3C1
Acquirer
Peoples Trust Company
888 Dunsmuir Street, Suite 1400
Vancouver, BC V6C 3K4
Fees/Rates
List of main fees and rates under this Merchant Application:
Monthly Service Fee
$_________
Transaction
Fee
$_________/transaction
Blended
Rate
_________%
Qualified
Rate
_________%
Mid-Qualified Rate
_________%
Non-Qualified
Rate
_________%
Interchange
Plus
_________%
Chargeback
Fee
$
25/chargeback
Chargeback Reversal Fee
$ 10/reversal
Retrieval Request Fee
$ 10/request
American Express
$_________/transaction
Statements
Merchants can view statements online at any time. NETBANX will provide the merchant with access to
its back office that at https://login.netbanx.com. Here the merchant will be able to view messages
from NETBANX, generate activity reports, and view account statements.
Expiry and Renewal
The Merchant Agreement will be effective once Peoples Trust accepts it and, unless otherwise
terminat-ed, will continue for (3) three years with automatic two-year renewals thereafter until Merchant
pro-vides written notice of non-renewal given not less than 30 days before the end of the then current
term.
For complete details, see section 4 of the Merchant Terms and Conditions.
Complaint-Handling Procedures
Email: support@championsway.com
Phone: 877-774-5425
Contract Cancellation
The processing Application/Agreement can be cancelled without penalty within 90 days of a fee increase
or new fee.
There is a fee to cancel the Application/Agreement for any other reason. See section 4 of the Merchant
Terms and Conditions
E-commerce Application
PerfectMind
Suite 110 - 980, West 1st Street
North Vancouver, BC
Canada, V7P 3N4
877-774-5425
customersuccess@championsway.com
PerfectMind/Championsway
10.00
0.20
2.89
0.20
Merchant Name (DBA or Trade Name) ________________________________________________ Corporate Legal Name (If different) ____________________________________________ Location Address _________________________________________________________________ Corporate Address (If different) _______________________________________________ City __________________________ Province _____________________ Postal Code __________ City _________________________ Province __________________ Postal Code ________ Contact Name __________________________________________________ Contact Email ______________________________________________________________
Contact Telephone # ____________________________________________ Contact Fax # ___________________________ Customer Service # ______________________________
Technical Contact Telephone # _______________________________________ Technical Contact Email _______________________________________
Federal Tax # ______________
Information to Appear on Consumer Statement (Max. 25 characters, including phone number and spaces)
Business Name _____________________________________ Phone # _________________ Company Web Site ______________________________ (If applicable) Monthly Payment Card Volume
$ ______________________
Average Ticket Amount $ ___________________
Highest Ticket Amount $ _________________
Does This Location Currently Take Payment Cards? No Yes Will You Be Keeping Your Account? No Yes Reason for Leaving Current Processor?
_______________________________________________________ Do You Need the Ability to Process Recurring Transactions?
No Yes
Fully Describe the Product or Service Being Offered.
________________________________________________________________________________________ ________________________________________________________________________________________ Years in Business ________ Years Processing (If different) ________
Ownership Corporation Individual/Sole Proprietor Partnership Publicly Traded Government Non-Profit(Must provide 501-C, or other proof) LLC
Principals (Must equal at least 51% of ownership)
Principal Name
First______________________________ Middle__________ Last___________________________ % Ownership_________ SIN__________________ Driver’s License_____________ Title______________________________ Date of Birth (dd/mm/yy)________________
Home Address__________________________________________________ City_______________________ Province__________ Country___________________ Postal Code_____________ Home Phone ____________________________________ Cell Phone____________________________________ Email Address ____________________________________________________ Principal Name
First______________________________ Middle__________ Last___________________________ % Ownership_________ SIN__________________ Driver’s License_____________ Title______________________________ Date of Birth (dd/mm/yy)________________
Home Address__________________________________________________ City_______________________ Province__________ Country___________________ Postal Code_____________ Home Phone ____________________________________ Cell Phone____________________________________ Email Address ____________________________________________________ Have Merchant or Owners/Principals Ever Had a Processing Agreement Terminated by a Bank? No Yes Reason for Termination _______________________________________________ Have Merchant or Owners/Principals Ever Filed For Business Bankruptcy Personal Bankruptcy If Yes, Indicate Year ___________________
Depository Bank Account Information
Attach voided cheque for the account listed Name must match legal or DBA name listed on cheque.
By providing the following reference information, you are authorizing Bank to initiate EFT debit and credit transactions to said account.
Account Type Chequing Savings Transit # _______________ Bank __________________ Account # ______________________________
Other Cards Accepted (Indicate account number for existing accounts below) American Express ________________________________ Apply Other ________________________________ Processing Currency CAD USD Agree to accept Visa Debit in a Card Not Present transactions environment
Do you take payments for memberships, subscriptions, or packages? Yes No
If Yes, please provide the usual breakdown of transactions (by % of total sales) and their respective price points.
B
U S I N E S S
I
N F O R M A T I O N
Membership/Subscription Period Package (e.g., 10 credits or 5 passes) Price Point Percentage of Sales Weekly Monthly Quarterly Six-Monthly Annually Other
✔
✔
Ownership Corporation Individual/Sole Proprietor Partnership Publicly Traded Government Non-Profit(Must provide 501-C, or other proof) LLC
Monthly Memberships
$1200.00
90%
X
200.00
2000.00
20000.00
v.013014
4 of 5
Initial Here _____________
NBX M
ERCHANT
S
ERVICES
I
NC
.
Merchant Application
888 Dunsmuir St. Suite 1400 Vancouver, BC V6C 3K4 3500 Blvd. de Maisonneuve W., Suite 700 Montreal, QC H3Z 3C1 Tel (866) 826-8003 sales@optimalpayments.comM
ERCHANT
A
PPLICATION
AND
A
GREEMENT
A
CCEPTANCE
By executing this Merchant Application on behalf of the merchant described above including its principals (“Merchant”), the undersigned individual(s) represent(s), warrant(s), acknowledges(s) and agree(s) that: (i) All information contained in this Merchant Application is true, correct and complete as of the date of this Merchant Application; (ii) If the Merchant is a corporation, limited liability company, or partnership, the individual(s) executing this Merchant Application have the requisite legal power and authority to complete and submit this Merchant Application on behalf of the Merchant and to make and provide the acknowledgements, authoriza-tions and agreements set forth herein on behalf of the Merchant and individually; (iii) The information contained in this Merchant Application is provided for the purpose of obtaining, or maintaining, a merchant account for the Merchant with the Sponsor Financial Institution, Peoples Trust Company (“Peoples Trust”) and Peoples Trust will rely on the information provided herein in its approval process and in setting the applicable Discount Rate; (iv) Peoples Trust is authorized to investigate, either through its own agents or through credit bureaus/agencies, the credit of the Merchant and each person listed on this Merchant Application and any personally identifiable information collected through this Merchant Application and the credit verification process will be used and disclosed in accordance with Peoples Trust Privacy Policy and only for the purpose of determining eligibility for qualification as a Merchant and as required by law; (v) Peoples Trust will determine all rates, fees and charges and notify Merchant of the approved fees and by Merchant's submission and acceptance of Merchant's first settled transaction, Merchant agrees to pay such approved fees; (vi) The Merchant Agreement will not take effect until Merchant has been approved by Peoples Trust and a Merchant number has been issued to merchant; and (vii) The undersigned declares that he/she has received, read, and understood, the Merchant Agreement (including the Terms and Conditions, available from the NBX Sales Representative), and agrees on behalf of the merchant to be bound by the terms of such Merchant Agreement. The Merchant on whose behalf this Merchant Application is being submitted acknowledges that this Mer-chant Application is being submitted to Peoples Trust as the Sponsor Financial Institution by NBX MerMer-chant Services Inc. (“NBX”), NBX shall also be a party to this MerMer-chant Agreement. MerMer-chant acknowledges that NBX will rely on the representations and warranties set forth in the Merchant Application and Merchant Agreement and unless otherwise specified or prohibited by Association or Applicable Law, NBX will have all the rights of Peoples Trust under this Merchant Application and the Merchant Agreement.
By signing below, each individual or entity (“Guarantor”) jointly and severally (if there is more than one Guarantor) and unconditionally guarantees to NBX and Peoples Trust the prompt payment and full and complete performance of all obligations of the Merchant identified above under the Merchant Agreement, as amended from time to time, including, without limitation, all promises and covenants of the Merchant, and all amounts payable by the Merchant under the Merchant Agreement, including, without limitation, charges, interest, costs and other expenses, such as legal fees, court costs and other costs. This means, among other things, that NBX or Peoples Trust can demand performance or payment from any Guarantor if the Merchant fails to perform any obligation or pay what the Merchant owes under the Merchant Agreement. Each Guarantor further agrees that: (a) NBX and Peoples Trust each may delay enforcing any of its rights under this guaranty without losing such rights and Guarantor hereby waives any applicable Statute of Limitations; (b) NBX and Peoples Trust each can demand payment from such Guarantor without first seeking payment from the Merchant or any other Guarantor or from any security held by Peoples Trust; and (c) such Guarantor will pay all court costs, legal fees, and other costs including collection costs incurred by either NBX or Peoples Trust in connection with the enforcement of the Merchant Agreement or this Guaranty, whether or not there is a lawsuit, and such additional fees and costs as may be directed by a court. If the Merchant is a corporation or limited liability company, this Guaranty must be executed by a principal of Merchant.
By signing below Merchant further acknowledges that they have read, understand and agree to be bound by the terms of PCI Compliance as described on this site: www.visa.com/cisp.
Merchant
Principal #1 __________________________________ Title _________________________ Principal Name __________________________________ Date _________________________ Principal #2 __________________________________ Title _________________________ Principal Name __________________________________ Date _________________________
Peoples Trust
By ____________________________________________ Title ______________________ Name ___________________________________________ Date ____________________
NBX Merchant Services Inc.
By ____________________________________________ Title ______________________ Name ___________________________________________ Date ____________________
B
ANK
D
ISCLOSURE
The responsibilities listed above do not supersede terms of the Merchant Agreement and are provided to ensure the Merchant understands some important obligations of each party and that the Visa, MasterCard, Interac Member – Peoples Trust - is the party ultimately responsible for the Bank Responsibilities.
Principal Name: __________________________________________________________________ Title: ______________________________ Principal Signature: _______________________________________________________________ Date: ______________________________
Member Bank Information: Peoples Trust Company , 888 Dunsmuir Street, Vancouver, BC, V6C 3K4 Tel. (604) 683-2881 Important Bank Responsibilities:
1. Peoples Trust is the only entity approved to extend acceptance of Visa, MasterCard, Interac products directly to a Merchant.
2. Peoples Trust is responsible for educating ISO, and ISO is in turn responsible for educating Merchants, on pertinent Visa, MasterCard, Interac operating regulations with which Merchants must comply.
3. Peoples Trust, not the ISO, must hold, administer and control all reserve funds derived from settlement. 4. Peoples Trust, not the ISO, must hold, administer and control settlement funds for the Merchant. 5. Peoples Trust must be a principal (signer) to the Merchant Agreement
Merchant Information: Refer to Merchant Application Important Merchant Responsibilities:
1. Complying with cardholder data security and storage requirements 2. Maintaining fraud and chargebacks below established thresholds 3. Reviewing and understanding the Merchant Agreement 4. Complying with Visa, MasterCard, Interac operating regulations
